Sunday, 6 November 2011

On Friday 21st October, I posted my last update about IVF and then the Fella and I departed for the hospital. I had been booked in for a 40 Week induction by my OB, due to my age (here they have concerns about the speed of placenta breakdown and the increased risk of still births in women over 40).

After 2.5 days of prostaglandin treatment as an outpatient (returning to the hopital every 6-12 hours for reassessment and spending 2-5 hours there at each visit), my induction was written off as a failure. On Sunday afternoon, I was scheduled into the OR for an unplanned c-section, which - as a procedure and an experience - terrified the living daylights out of me.

The only good thing about it?

Spud: born 23rd October, 7lb 90z, 53cm long. Intact and healthy. Snapped just after being wheeled up to the post partum ward from Rocovery.

Friday, 21 October 2011

There was a point during our cycle of IVF when I joked to someone that if we were lucky enough to have a child, that I would really look forward to telling my child all about the birds and the bees. Well, you see, darling, it all starts with needles...

...lots of them. Now some people breeze through this part of IVF without a backward glance but if you happen to a bit needle phobic, like me, then you are in for a bumpier ride. Just to put all of those needles into context, IVF breaks down into the following basic stages for a woman:

- egg production (in my case this took approximately 27-28 injections, 8 blood tests and 8-9 vaginal ultrasounds);
- egg retrieval (IV plus the whopping needle used to hoover out my eggs);
- egg fertilisation (well that involved a needle but thankfully it was not stuck in me); and
- embryo transfer (I think that this was needle free, but it was certainly not catheter free).

I should say at this point that I have a tendency to faint when people brandish a needle at me so I have to tell you that I am very proud of myself for surviving all of the above without passing out and bruising my forehead on a piece of hospital furniture. That, in itself, was a miracle.

I should also say at this point that having read up on IVF, the processes, procedures, choices and paperwork before we started our cycle of IVF, it was my ideal scenario to go through the above process, produce a bumper crop of eggs (of course) and have at least 4 of them fertilise. This would give me the option to use two embryos in this IVF cycle and freeze down the other two for a second 'go' later. Either if the first cycle failed or if we were successful and decided to try for a second child later. Really. Ok, you can stop laughing at my naivety now.

I really should say that this is a very long blog post. Sorry about that. It's just the way that it turned out.

Egg Production

Once I was a couple of days into the process (only 1 injection per day for the first two days, which the nurses handled in order to demonstrate how and where the drugs should be injected), I was supposed to inject my tummy or upper thighs with two drugs per day to stimulate egg production and manage my cycle - FSH and Buserelin.

Being a logical person, I decided to use one side of me for one type of drug and the other side of me for the other. As you do. What did tickle me (this is from my very unscientific packet reading and internet research) was that the two IVF drugs - well, one was made from hormones extracted from the urine of post menopausal women and the other's primary use is in the pallative care of men with prostate cancer. Isn't that quite the party?

The only problem was that I was supposed to inject myself with these drugs and I just couldn't do it. I tried and I failed. The Fella tried and he failed. Neither of us could do it. I sat at our dining table, drugs and syringes laid out in front of me like some kind of serious drug addict and I could not overcome 40 years of needle phobia and neither of us could overcome our conditioning not to hurt ourselves (or anyone else) on sharp, pointy objects. Either we would think that we were pushing the needle in but it turned out that we were not (as it wouldn't go in, just created a dent in the skin) or it would just pierce the skin with a sensation that felt (both to me and the Fella) like a ballpoint pen being pushed dully through a piece of clingfilm. Whereapon we'd either recoil in panic (dropping the syringe on the floor, contaminating it and wasting our drugs) or not be able to push the rest of the needle in.

I phoned the hospital and explained our problem. Luckily, the nurses have come across people like us before. So I had to go into the hospital every afternoon for the remainder of our IVF cycle to get a nurse to do my jabs for me. Pathetic but true. Personally, I found that the drugs stang after they were injected. By the time I reached the egg harvesting stage, my abdomen sported a whole constellation of scattered injection bruises, my hormonal balance had been so upset I was a raging basket case and my ovaries felt like they were trying to bulge rudely (and uncomfortably) out of my pelvis.

On top of the injections, from Day 3 of the IVF cycle onwards, I had to be at the hospital at 8am every other morning for a blood test and a vaginal ultrasound. The Fella nicknamed this 'The Breakfast Club'. I didn't really speak to any of the other women that I met in the Breakfast Club blood test corridor or ultrasound waiting room. Other than the odd smile and nod of recognition, we were all very quiet. Towards the end of the cycle, this became a daily appointment. The blood tests were just more needle misery that I pretended to be stoic about and the ultrasound became affectionately known in our household as the 'light sabre treatment'. I have to be honest, it was silent, but somehow it really helped me to imagine the light sabre noise in my head as I could feel the ultrasound probe swinging first to the left and then to the right in order to scan my ovaries so that the specialist could count how many egg follicles they were producing. By helping, I mean that it distracted me from the fact that I was reclining on a chair, knickers off, socks on, covered in a modesty sheet, being probed by a piece of hospital ultrasound equipment.

After every blood test, I had to ring the hospital at noon to find out my blood test results and whether my drug dosage was being altered. After which, I would go hang around the pharmacy to buy more drugs and take them into the hospital for a nurse to do the jabbing honours. Rinse, repeat for 14 days (in my case).

This was quite a stressful, emotional time for us as a couple. Apart from the fact that my hormones were completely messed up, I did not respond to the drugs either as quickly or well as the hospital expected. I didn't realise there was a problem until about halfway through the IVF cycle when a doctor I had not met before did my ultrasound and commented, effectively, that my body needed to buck up its ideas and try harder because only 5 egg follicles were starting to look viable (I started with 9 or 10 but they did not all develop). As a result, I was starting to look borderline in terms of whether there was any point moving onto the egg retrieval process (the hospital will not go to egg retrieval for anything less than 4 follicles). They ramped up my FSH drug. I fussed very badly because there was absolutely nothing that I could do to 'buck up my body' or control how my body responded to the drugs they had instructed me to take. They ramped up my FSH drug some more, the IVF cycle dragged on but no more egg follicles matured. I felt very despondent. We reached the crunch point where we really needed to either proceed to egg retrieval or cancel the cycle.

You see, despite the drugs you take to control your cycle, the IVF egg production process does have a clock ticking. It gets to the point in an IVF cycle where you have to act, retrieve the eggs, fertilise them and get embryos back in before the uterus lining starts to prepare itself to shed. There is an optimum window for embryos 'to stick' and if you miss it, the IVF cycle is very likely to fail.

We had a difficult conversation with one of the specialists about whether we should or should not proceed to egg retrieval. She was honest but very careful to tell us that this had to be our decision - our case was not optimal, I did not have many egg follicles and we were really pushing my cycle, so the odds of us being successful were diminishing fast. She estimated that the chances of us becoming pregnant had dropped to around 20% from 30-35% so we were very likely to need another cycle of IVF if we wanted to become pregnant.

However, she also warned us that we needed to be aware that this might be just as good as it ever gets - what would we do if there were fewer eggs next time? She'd had cases where there were lots of egg follicles but the eggs turned out to be very poor quality. She'd had cases where there were very few egg follicles but the eggs were all very good quality. With us, she pointed out that there was no case history established for us that identified whether the number of follicles in this cycle was typical and no data on whether my eggs were any good. If it was a question of finances, then we could cancel and try again in another 2-3 months time and hope for a better outcome. However, the way that she said it, left us both with the impression that we should consider continuing. She had to leave in order to do a procedure for another couple.

We sat with one of the IVF nurses and hashed the problem backwards and forwards, looking at the pros and the cons of going to egg retrieval. I would be lying if I said that finances were not a big part of that discussion. By that point, we were at least $5,000 into the procedure (hospital treatment and drugs). If we continued, the remainder of the cycle would cost a further $5,000. So really, the question was whether to proceed so that the hospital could build up a full cycle case history on us or bail and put the $5,000 we saved towards another, potentially better cycle with better odds. It was a very miserable and upsetting discussion.

In the end, we decided to continue. We made this decision on the basis that it would give the hospital a full case history on us, which might improve our chances in the future. We also made it on the basis that having two full attempts at IVF for $20,000 had to be better than one and a half attempts for $15,000. After all, if we were successful, even if our odds were very low, we wouldn't need the second cycle. Also, I have to acknowledge that there was a part of me that did not want to have gone through such an expensive, exhausting experience and walk away, mid process.

Also, notice how we were committing ourselves mentally to another round of IVF if this one failed? After starting this whole process by saying that we would give it one single go and if it didn't work out, that we would get on with our childless lives and not get sucked into further cycles of treatment? I think that this is how it happens, how people are drawn in and how doggedly determined they can become about having a baby at any cost - the hope extended by IVF can be a cruel, expensive thing.

Egg Retrieval

This took place at about 10:30am on Sunday 30th January 2011. We showed up at the hospital, I donned a hospital gown, gave my music to the nurse to play during the procedure (Amplified Heart by Everything But The Girl), sat in a chair and freaked out quietly about the IV needle in my hand. I made them put tape over it so that I couldn't see the needle poked into my skin. The Fella had to vanish into a little room to well, you know, do his part! Once he returned, they took me through to the procedure room where I climbed onto the bed and put my feet into the handy holders (in my trademark black ankle socks), lay back, tried not to dwell too much on what was about to happen and held the Fella's hand like it was my anchor to the earth. At that point, they started some kind of happy, relaxant drug in my IV and once that kicked in, I didn't care at all about what was about to happen.

A new specialist that I had not met before did the procedure and he was both quick and efficient. After injecting something to numb the area, he used a whopping great needle to stab through the walls of my vagina into each egg follicle on my ovaries. He proceded to suck out each egg. How do I know this? Well, he had positioned a screen so that I could see what was going on via the ultrasound image. It might sound biazarre but it really helped to see what I could feel going on 'down below'. It wasn't painful, I could just feel the jiggling around. The lab staff came into the procedure room, took my eggs away and confirmed an egg count. Six eggs - one more than we expected! I was so relieved (as sometimes, they cannot reach all of the eggs) that I burst into tears. Once the procedure was over, I had to spend an hour in recovery, then go home and take things easy.

Egg Fertilisation

The lab fertilises your eggs on the same day that they remove them. They prepare the eggs and sperm and in the case of ICSI IVF, they inject individual sperm into each egg. They leave them and wait to see if any embryos develop. Depending on what IVF process you are following, embryos are implanted back into your uterus either on Day 3 or Day 5. In our case, we were due to be implanted with our embryos on Day 3. We had to wait for a phonecall from the lab on Day 2 to tell us if any of our eggs had fertilised and how many embryos we had suitable for implantation.

As I am 40, the hospital would have agreed to implant up to three embryos, to give me the best possible chance of conceiving. Under 40, they tend to implant a maximum of two embryos. If you recall, we had already decided that we would only implant two embryos and save any others for later.

This all turned out to be a very moot point. When the phonecall came through, it turned out that only three of my six eggs had been mature. The lab cannot inject immature eggs, so in a matter of seconds during this phonecall report, our six egg count halved. Sadly, of my three mature eggs, only one had fertilised. So we only had one embryo. A single, lonely, only embryo. Bang went my secret hope for twins and bang went my hope of having a second 'go' from one round of egg production. I made polite noises to the nurse and hung up the phone.

Then I realised. Don't be stupid. Just think how close you just came to having been through all of that and ending up with no embryo to implant at all. I rang my dad in the UK, gave him a progress update and with his usual good humour, he immediately named our lonely little embryo, 'Bob Hope'. If you are British, you will probably get the joke, 'You've got two hopes...and one of them is Bob Hope!' (The other is no hope.)

Embryo Transfer

This was very straightforward as well. It happened for us at about 10:30am on 2nd February, 2011. We were scheduled to have our embryo implanted after another couple had had their eggs out. I only mention this because their music was left on in the procedure toom during our embryo implantation. Again, I donned a hospital gown. This time, no IV was needed. The same specialist who had removed my eggs did the embryo transfer. He inserted a catheter into my uterus, measured it and told us that he aimed to pop our embryo into my uterus, not quite at the back, so that it wouldn't float back up into a fallopian tube. He used ultrasound while he worked out what was what but then advised us that the procedure itself is done blind as ultrasound waves are not good for an embryo. A lab tech strolled in and advised us that our little Bob Hope was a grade 3, 10 cell embryo. We must have looked a bit worried as it was very hastily explained that the hospital had had successful pregnancies from grade 5 embryos.

There was a short delay and the lab technicans walked in with what looked like a clear plastic tube. I held the Fella's hand and stared at the ceiling while there was some jiggling around at my lower end. The previous couple's music was still playing and it was some kind of light music being played on what sounded to me like traditional Chinese orchestral instruments. As little Bob Hope was transferred I realised that I was listening to an instrumental cover of 'A Whiter Shade of Pale' by Procol Harum. It's odd what you notice at times like this. With great ceremony, the lab technicans took away the plastic tube, checked it and announced that the embryo was no longer in the tube. Pretty much, that was it. I looked over at the Fella and said, "I love you darling but you really need to work on your foreplay."

After the procedure, I was wheeled out to recovery and told to rest for an hour. After that, advice conflicted slightly. The hospital paperwork suggested bed rest for two days but the specialist told us that this wasn't really necessary. I hedged my bets, took things easy for a couple of days and lounged about on our bed reading a lot. I have no idea whether my fear was in any way rational but I was just terrified that the embryo would simply fall out. After all, what was there to keep it in?!

After IVF

Once you've completed IVF, you wait. You have to eat, drink and behave like a pregnant woman (both during and after the cycle) but you do not know if you are pregnant. You have to wait 14 days and then go for a hCG pregnancy blood test to see if the embryo has 'stuck'. If the results are either positive or ambiguous, you have to go for another blood test at 21 days to either confirm the results and/or verify that your hormone levels are rising in a way that suggests a viable pregnancy.

It was a very long two weeks. We waited, continued to eat and drink according to all of the pregnancy rules, told Bob Hope that it was well worth sticking around for the family grub and tried very hard not to fall in love too much with the idea that we might be pregnant while behaving exactly as though we were pregnant in case we were not pregnant. It's actually a lot harder to do than it sounds.

On the day of the blood test, I was at the lab early. The hospital told me that they would phone through the results at about 2:30pm. I waited in for their call but it didn't come. I phoned them. The lab results were not yet in. In BC, there is an online service that enables you to get your test results as soon as the lab publish them. Although I had wanted the hospital to tell me the test results, in case I interpreted them wrongly, I went online and spent about two hours constantly hitting the refresh button on the blood test report. Finally it came through. I opened it....and I wasn't sure what it meant.

It sort of looked like it might be positive news but I was terrified that I was interpreting it wrongly. I phoned the Fella at work and explained the problem. Together, we looked online for what different hCG levels meant but neither of us were certain and neither of us wanted to get our hopes up artifically. I hung up the phone and it rang immediately. It was the hospital. The nurse said, "Well, it seems that I have nothing but good news for you today. Congratulations, you are pregnant! You have to go for another blood test in 7 days time to verify that the pregnancy is viable."

That folks, is how we found out that we were expecting our baby. We were lucky enough to learn that our pregnancy was viable at the next bloodtest. Then, once we'd seen our tiny embryo at our 6 (8) week scan, our little only, lonely Bob Hope officially became Spud. We waited a long time to announce our pregnancy because we were terrified about the prospect of a miscarriage and once that danger was past, we had to have a series of tests to make sure that the baby was low risk for chromosomal problems (due to our ages).

We know that we were extremely lucky with our IVF treatment as our chances of getting pregnant in that cycle were so low. I have since met a couple who have just had their first baby after 8 years of failed IVF treatment. I just cannot begin to imagine the heartbreak, misery and disappointment that those eight years brought them and what strength and determination it must have taken for them to continue their quest for children.

So now - I am almost 40 weeks. Spud is due. In fact, because of my age, viewed as being overdue. If the baby doesn't trigger a spontaneous exit very soon, the hospital will want to induce me (due to fears about how quickly the placenta can deteriorate in women over 40 after Week 40).

On one hand, it's been a very long haul with lots of anxiety about the pregnancy and lots of worry about whether Spud is okay. I suspect that a bit of extra worry is natural for people who have been through the mill of IVF. I sort of feel like I have been pregnant and worrying about this baby forever.

Quite needlessly, probably. We seem to have had a very straightforward pregnancy. We've been exceptionally lucky with our prenatal care as our OB has given us an ultrasound every month, so we've been able to 'have a visit' with our baby, see how it is developing and see what it is doing when it bumps around inside me. This has been fantastically reassuring for us.

On the other hand, it feels like this year has whizzed past and I can hardly believe that this wriggly creature inside me is due to come out. I really want to meet Spud - I really want to see, hold and pat my baby's wriggly bottom.

Wednesday, 19 October 2011

I have reflected a bit on my previous post and it falls short of the post that I thought that I would write about our fertility journey over the past 2-3 years. Every time I thought about writing something down during this time, I saw witty comments and cartoon drawings of the most ridiculous moments - so far, not so good. However, I feel that if I don't write this stuff down before our baby arrives, the moment will be gone. So please bear with me. I am writing this all down as much for me as anyone else. I am writing each post as I go, so they may not be as tightly written as they should be.

I do not know for certain but I suspect that people tend not to talk about treatments and procedures because either they are trying to forget them, normalise them or are trying not put off other people who might have to experience them. The truth is though, that some procedures, especially fertility related ones, are fairly extraordinary. It's been 9-10 months and I still haven't been able to normalise them. In some respects, I think that they should stand out as something quite odd (or amazing, whichever way you wish to look at it). I hope that my personal experience of them doesn't put anyone off. If you are having difficulties with fertility, asking for help, receiving treatment and having a successful outcome more than compensates for any of the procedures that you have to go through.

Our first appointment at the hospital was a bit of a non event, a quick meet and greet, a review of our file and a dispatch for more tests. The Fella was sent for more tests and told to review the medications he'd been prescribed to stabilise his blood pressure with his usual doctor as the side effects of some of them were known to cause fertility problems. I was dispatched for a Hysterosalpingogram (HSG) test (wiki link). The fertility specialist told me that this test was both 'diagnostic and therapeutic'. Basically, it's an x-ray of the uterus and fallopian tubes. The way our consultant put it almost made it sound like a relaxing spa treatment - it sounds fairly benign, right?

Well, trust me, it felt a lot less benign when I was stripped from the waist down (apart from my M&S black ankle socks), lying under a skimpy paper towel and x-ray machine on a cold metal slab, in a dimmed room, waiting for the x-ray to happen. The nurse had explained the procedure to me but I still felt like I'd entered another dimension of the bizarre when the x-ray guru entered the room with a miner's lamp strapped to his forehead.

You see, they have to squirt dye up inside you in order for the x-ray machine to see any of your reproductive organs. So the x-ray guru has to insert a catheter up into your uterus and squirt in the dye. Are you squirming uncomfortably yet?! I was - even before he'd switched on his lamp. This is also where I learnt first hand, for the first time, that when a medical person says, "You might feel some cramping," what they really mean is, "This is really going to flipping hurt - brace yourself." I was expecting a bit of cramping, I wasn't expecting the kind of 'cramping' that shot me halfway up the metal slab and almost had the x-ray guru's eye out on the toe of one of my black socks!

Luckily, it didn't last long and the x-ray guru left the room before I could regain my composure sufficiently to fling myself off the slab and ping his forehead forcefully with his miner's lamp. I commented lamely to the nurse that it hurt a bit more than 'cramping' and she commented helpfully, "Well, it hurts a lot less than childbirth."

That's right, I thought, just the thing to say to a potentially infertile woman, who's sitting on a metal slab with her knickers off and trying to come to terms with the fact that she's just had her insides invaded by dye and a man wearing a miner's lamp.

So why was this test both diagnostic and therapeutic? Well, the x-ray enables them to check your vital reproductive bits. Squirting the dye through your reproductive system, flushes it out. So it is possible that if you had something blocking a fallopian tube, it would be removed and voila! Your fertility problem would be solved.

At our next appointment, the specialist confirmed that all my bits were present, correct and free of any blockages. He looked over the Fella's test results and advised that things had not improved, despite the changes implemented around multi-vitamins, lifestyle and blood pressure medication. In fact, his results were slightly worse. Mind you, it is important to remember that it takes about 3 months for any changes to be processed through a man's body completely, so it is possible that some of the changes the Fella had made were just not reflected in his results at that point in time.

The specialist advised us that there were avenues that he could pursue that might or might not help to improve our fertility situation but that it would take over a year for us to begin to see any beneficial results, if there even were any. Due to the uncertainty of success and our ages, he felt that we should consider some form of assisted reproductive treatment instead. Based on our specific situation, he recommended ICSI IVF. This is the type of IVF where individual sperm are injected into each egg.

As we were in December and approaching Christmas, he suggested that we start our IVF cycle in January - so that is what we did.

Thursday, 13 October 2011

I thought that I knew all about the birds and the bees. Living on a small holding for a few years in West Wales back when I was in single digits quickly put paid to any notion of the cabbage patch or the stork. Even if I had wanted to ignore what the animals were all up to out in the fields, it was hard to ignore the facts of life when we popped Harriet, my goat, into the back of my parent's Morris Minor Traveller (complete with interesting fungi growing on the wood inside the boot) and took her off to a local, rather smelly, billy goat 'to be serviced'. A quick wag of her tail (well, she was in season), on hopped the smelly Billy and, 150 or so days later, out popped her beautiful little kid - simple really.

Then later when I was an adult and in relationships - I was suitably careful. After all, the bird and the bees rules are very simple - take one girl and one boy. Mix thoroughly and 9 months later, baby very likely to pop out - or so I thought. Who knew that the whole topic of the birds and the bees could get so blooming tricky and involved?! Certainly not me.

Ignorantly, when I married the Fella, I thought that the biggest task we faced would be discussing the whole topic of changing our lives radically by starting a family, becoming parents and incorporating a child into our lives - making the enormous decision to start 'trying for a baby' officially. It might sound strange, but after almost 20 years of dating and being a 'Sink'ie (Single Income, No Kids) before I met my husband (who already had a teenage son and likely thought that his parenting days were coming to an end), it's quite the topic to discuss and decision to make.

As it turned out, the decision was not that hard. We both wanted children together. So, really, I could not have been more wrong about the real task that we actually faced.

To begin with, we were completely laid back about the whole thing. 'If it happens, great - if it doesn't, no problem at all - that's also fine.' There was a sort of excitement mixed with trepidation at the uncertainty of it all every month - would it happen, would it be this month?! No...no...no.

After a number of months, a little alarm bell of concern started to ring at the back of my head so I bought some of those ovulation kits. When I found myself staring at a shelf in a supermarket, debating the merits of one brand of stick over another brand of stick in my head, I realised that I was crossing some kind of invisible line from casually trying for a baby to actually trying for a baby.

For a while there, I applied myself enthusiastically. However, all that resulted from my purchases were a number of months where I logged my cycles, peed on ovulation sticks and tried to romance the Fella at the appropriate times. Naturally enough, my romantic timing always stank. 'The right time' always seemed to conflict with when we are both too exhausted or busy to do anything about it. One way or another, the whole thing was an unmitigated disaster. So I abandoned it before it started to have a serious impact on our relationship.

We went back to our, 'If it happens, great - if it doesn't, that's also fine,' approach but I have to be honest, there was no excitement or trepidation for me each month. By this time, it had been over a year and I pretty much knew by this point that no month would ever be 'the month'. I felt very flat about it. I worried about my age. I started to read online about how much harder it was for women over 35 to conceive and maintain a pregnancy. I assumed, as the Fella had his son from his first marriage, that our inability to get pregnant was my fault in some way and I felt wretched about it. I also worried about the Fella's age - not because of his health but because the longer it took us to get pregnant, the more worried about being 'too old to be a dad' he would start to feel. I have to admit that I was worried that we might reach a point where he would want to stop trying for a baby before I was ready to give up on the idea of us having children together - I just didn't know what impact that would have on us as a couple.

It was about this time that I handed myself into a doctor. I discovered, as an aside, that I had an autoimmune thyroid problem. I have blogged about my struggles on this front already. I might not have been so determined in my pursuit of treatment if I had not found out that thyroid problems can have a serious impact on fertility and unborn babies. It took some time but I did eventually get treatment which eventually brought my thyroid hormone levels into the correct range to both conceive and sustain a pregnancy successfully. At this point, I felt quite hopeful again. However, nothing happened and so my doctor agreed to refer us, as a couple, to a fertility clinic for assessment.

This meant that the Fella had to have some standard tests before our hospital appointment materialised - just so that there was a full case information on us both. To our mutual surprise, the results of his test were not that great. He was referred to a urologist who advised him to make some simple lifestyle changes and to start taking vitamins. He duly made the changes and started to take the vitamins. We waited for our hospital referral to come through.

In the end, it took about three months for us to receive our first hospital appointment. By this point, it had been about 20 months since we had started to try for a baby and I think that both of us were mentally trying to reconcile ourselves to the fact that children just might not ever happen for us. I felt quite sad about it.

This said, before we went to our first hospital appointment, we talked at length together about the prospect of being offered some kind of assisted reproductive treatment and how comfortable we felt about it. We discussed couples that we either knew or had heard about through others whose relationships had been destroyed by endless rounds of fruitless, expensive treatment. We decided that if IVF was suggested, then we would give it 'a go' but that we would not get sucked into rounds and rounds of it. We just did not think that we could afford it - either emotionally or financially (IVF treatment has no public funding in British Columbia). We agreed that trying for a child was important to us but also that we were important to us too - so, if we were offered IVF and it failed, we needed to be prepared to pick ourselves up and plan a future together without children.

Our view was, "We should do this and have one proper go at it. If we don't, then we could end up looking back in 10 years time and really regret it. We'll be sad and wonder why we never did it - there will always be a 'What if...? and 'I wonder what our child would have been like?' hanging over us. If we have a go and it doesn't work, then at least we will know that we tried, gave it a good, proper go but it was just not meant to be. At that point, we can move on."

We felt very sensible about the whole thing and thus prepared, we went to our first hospital appointment.

Friday, 7 October 2011

I am almost 38 weeks. Although pregnancies are usually 40 weeks, they warn you to expect your new arrival anytime between Week 38 and Week 42 (although they may not want me to go much past my due date due to my age). So our baby could make an appearance anytime over the next 2-3 weeks. This said, Spud is not showing any signs of wanting to exit any time soon - the baby has not dropped and there are no early warning signs that labour might be imminent.

At my OB appointment this week, I had a growth scan and Spud is now estimated to be about 7lbs and 11 ounces. The longer that Spud stays put, of course, the bigger Spud will get (an additional 0.5lb a week) so I am really hoping that this very wriggly creature that lives inside me will start saying goodbye to my innards and start scrunching up into a nice pelvis-dynamic shape ready for delivery very soon - I live in hope!

In the meantime, we have packed for the hospital, stocked up on shelf safe groceries, cooked up some meals and frozen them down for our return from hospital and I think that we are about as ready as we can get at home, without having a test baby to check whether we have things right or wrong. The baby may have an opinion too, so there are a few things that we are hanging back on until after Spud arrives.

Out of necessity (which happens to work out perfectly with Health Canada's latest recommendations on infant sleeping arrangements), Spud will be sharing a bedroom with us for the first 6 months - 1 year. So I don't have any pretty nursery pictures to show you - we have simply set up a Spud Zone in our bedroom:

I realise that this all looks a bit sterile, spartan and tidy but I don't expect it to stay like this once the baby arrives! Like the title of this blog post, this point in time really does feel like the calm before the storm. I expect this area to look like a hurricane has blown through it about 2-3 days after we are home from the hospital!

You can see our mini-crib reflected in the mirror - it just about fits alongside our bed. As we don't have a dedicated nursery, we got a cot (crib) system that we can wheel about the house (in case we need to park it in different rooms around the house) and that will size up as Spud grows. The only drawback is that it is oval - great for getting through doorways and around corners but a bit tricky when it comes to bedding. The proprietary bedding is both expensive and not readily available off-the-shelf here. So I bought one mattress protector and one sheet to use as a template and I've been working away in the background on my sewing machine to create some extras of my own. Not worth photographing but still, it's amazing what you can achieve, cost effectively, with some breathable nappy (diaper) wrap and some white cotton flannel! I am hoping to whip up some more bedding and and mattress protectors for the full sized version of the cot (crib) before Spud outgrows the mini-crib next year.

The other things that I have whipped up recently for Spud are some baby blankets because I couldn't bear to spend money on inferior ones when I knew that I could make better ones for myself (for the same or less money):

I know - seven blankets is probably excessive but once I started making them, I found it hard to stop! They are all double sided (mostly cotton flannel on both sides but a couple are cotton flannel on one side only) and made to my usual recipe (which I finally get to test for myself).

The green tortoise/turtles blanket is slightly different from the others. I included a layer of the breathable nappy (diaper) wrap inside it. The idea behind this is to either use it for walks on drizzly days next Spring or use it for baby bottom airing time. Any accidents and it can be dropped straight into the wash. I've only made one as I want to see how useful it is.

Although I've been busy on my sewing machine, I haven't made all that much for this baby other than the blankets and the bedding. Most of the things that we needed have been purchased: 0-3 month starter pack wardrobe as well as sundries like towels, washclothes and 12 white cotton flannel diaper squares to use as burp cloths.

I haven't done any knitting at all for Spud - for some reason, I am having a block about making things that I know will take me forever to do and only have a very short life span if Spud grows quickly. I know, I know, I should just make a bunch of baby projects in Big Wool, like this Rowan one. But...like I said, it's a block.

I do have two other sewing projects in progress for Spud - a quilt and a play mat, a bit like the one that I made recently for my niece, Lorna. I'm stalled on the quilt (haven't touched it since my MIL died in June and there's no way that I can finish it in time now) and I cannot show the play mat yet because I'm still a very long way from finishing it.

The quilt is in the same kind of colours as the change mat in the blankets photograph: teals, blues and lime greens. I am not sure why these colours happened. But they did. Interestingly, I've set up a guest room in our basement (as the reno is delayed and so that my parents can stay with us when they visit in November and December) and the colours downstairs seem to be white, navy blue and dark red - I am hoping to reuse some of the guest room things in Spud's nursery after the renovation is complete. So not sure how I'm going to integrate teal, blues and lime with the navy and dark red. Mind you, does anything in a child's life ever really match? I doubt it.

In terms of the play mat, the scope of the project seems to have exploded from a completely plain (and easy) denim pad (i.e. a few hours work) to something much more complicated (i.e. I've spent a whole week on it so far and it's nowhere near finished) because the Fella was worried that he wouldn't know which side of the mat should go 'up' and which side should go 'down' in terms of avoiding contaminating the baby and/or its baby blanket with the gruesome quantities of floor grot that invades our house every single day. It's okay, I have 2 weeks or so go. I feel confident that I'll finish it in time...maybe?!

The very last thing that you may have noticed in our Spud Zone is this pile of baby name books:

We bought 3 books, exhausted them without success and then bought 3 more, going for the bulk 60,001+ and 100,001+ titles. We still do not have a shortlist of names for our baby and now we dread opening any of the books at all as the task has become too overwhelming!

At this rate, we suspect that we'll be taking the books to the hospital and playing a blindfold game of 'Pin a Tail on the Donkey' to pick something out while distracting me during labour.

Monday, 3 October 2011

...although you could be forgiven for thinking so from my blog. There has been the occasional ray of sunshine that has made it through the branches of the cedars and shone through the windows of our little house in Vancouver. One of those rays of sunshine was the news that my incredibly talented and inspirational quilt teacher's article on machine beading had been published in the September 2011 edition of the American Quilter. I did the photographs to support her article.

Sadly, the magazine required me to sign away the rights to all of my images so I don't think that I can show you my actual, personal favourite images from the photography shoots on my blog, even though they did not use them in the magazine article. However, if you enjoy working with fabric and beads, I can recommend both my teacher's technique and her article in this magazine. I've used this technique in a number of different projects - it works and the end results look fantastic.

In terms of my contribution to this article, I did this piece of work sometime back in May or June 2010 and it was a really good, interesting experience. I was offered payment for my work but I turned it down on the basis that the learning opportunity was more valuable to me than the amount being offered by the magazine for my photographs.

The first thing that I learned was that I loved working with clients in my studio. In this case, my quilt teacher and her husband - it was a huge amount of fun. It also led me to acquire a photography reflector holder so that any future clients do not have to spend the day holding a reflector - just so - for each photograph. My quilt teacher's husband earnt his stripes that day.

The second thing that I learned was how much work goes into step-by-step photography. The magazine required approximately 100, magazine ready, supporting images for the article. I suspect that I thinned the final cut down to about 150 finished images? Trust me, I took a lot more photographs than that during the course of the project. In the end, the magazine used 13 of my images.

The project took three, one day studio shoots plus a further half day at my house to create some contextual, lifestyle type images. For each step in the tutorial, I took a series of different images in both landscape and portrait format (to give the magazine layout options). Once I'd thinned them down to a logical series of possible images, I had to colour correct them all, pretty much individually. My camera wouldn't read one of the project's fabric colours correctly (a green, which it stubbornly turned different shades of yellow) and at that point, I did not have any specialist colour correction tools and software.

This was another very big learning point for me. Do not attempt any kind of product photography work without proper colour correction tools. Particularly when you are doing work in a world where colour is really important (fabric and yarn). I own one of these tools now and I use it religiously in the studio and during post-production work. It was one of the first things that I bought after I'd spent hours at the computer painstakingly trying to correct my 150 final images by eye. In the end, I had to aim to green up the yellows and get them as consistent as possible with each other. So, if you spot any colour inconsistencies in the magazine images - I apologise, but trust me - I really tried very hard to get them all the same shade.

Otherwise, the final thing that I learned is that it's very odd seeing work that you have done in print, so long after it was completed. It was over a year between doing the work and seeing it in print. It was very exciting to receive the news about the article being published, race out, buy copies of the magazine and see my first ever work in print. At the same time, I've learnt so much about product photography since doing this project last year (I enjoyed this project so much that I took a formal course in product photography) that it's difficult for me to look back at my work without being very critical about my images. I still worry whether or not my quilt teacher was okay with my work and I hope very much that she felt that my images supported her article adequately.

I am not sure how many opportunities like this will come along in future. I hope that more do - simply because I enjoyed working on this project so much. It is possible that my quilt teacher will write some more sewing and quilting articles (as a sewer, I really hope so) but from reading her blog and seeing how well she captures work in progress with her own camera these days, I expect that she will be able to take care of her own photography in future!

P.s. 37 Weeks - so technically, I have 3 weeks until Spud arrives. All I can tell you is that I have a very wriggly tummy!

Tuesday, 13 September 2011

As you may recall, my niece was born w-a-a-a-y back in March. Now my sister lives in India. In a a bubbly froth of enthusiasm, I bought some yarn and fabric with the idea of whisking up a few semi-cordinated items to celebrate her arrival...

...and I almost made them all. I know, astonishing, isn't it?! I wrote off the knitted cardigan idea as being too impractical for a baby that spends most of its days in the sweltering heat of Bangalore but I did whip up a little newborn cotton knitted hat (because it was fun) and I made a decently sized, cotton flannel receiving blanket with some very cool fabric that I picked up at a local quilt show. Job done, I thought. Time to send it off to India and paste pictures of my work all over my blog to prove that I haven't, in fact, had my crafting hands cut off at the wrist.

I spoke to my parents in London to check that I had her address right. They warned me that over 50% of the gifts that people had mailed to her in India had 'vanished' en route. Very, very sensibly, they suggested that I post my gift to them in London for my sister to pick up on her next trip to the UK...in August.

I glanced at my gift in dismay and did a quick calculation in my head...April, May, June, July, August. Um, that meant that my niece would be 4-5 months old. This rather took the shine off my nice, bright, cheerful, handmade newborn gift. At the very least, I'd need to make a bigger hat.

I stared at my remaining yarn but truth be told, I just couldn't bring myself to make a replica hat in a bigger size. So, I decided to make something else. Something that would loosely co-ordinate with the receiving blanket that I had already made but would be appropriate for a 6-12 month old baby.
It took me some time to work out what I wanted to make. A part of my gift was prompted by a discussion that I observed between a group of quilters at the show where I bought the fabric for my niece's receiving blanket. Also, my gift took much longer to complete than I expected - well, all of my craft projects came to an abrupt halt when my MIL died in June and I've spent a lot of time this summer helping to sort out and clear out her house (I only finished up work at her house on the Labour Day weekend). However, I did manage to finish my gifts and get them to the UK in August, in time for my sister to pick it up and take it home with her to India.

My final package (snapped just before I bundled it into the post) contained:

The padded floor mat came about due to the conversation between quilters that I observed at the quilt show. The quilters, who had all lovingly made quilts for new family members, were absolutely horrified to find their quilts on the floor when they went to visit. I heard comments like, 'I hand embroidered it and it was being used as a rug!' and 'That happened to mine too - all that work and they were walking on it! I am never making anything for them ever again.'

Dwell Studio Fabric (sort of but not really, quilted. I stitched around the border and vertically through every other brown circle. I hope it's enough!)

Now I do understand - an enormous amount of effort goes into quilts - but why make something for a new baby that you do not expect to end up on the floor and/or smeared with some form of baby effluent or goop? After all, their world, is mainly at floor level for the first few years of their lives and they are not all that cordinated. The main thing on parent's minds is going to be how to protect them from the floor while they are having tummy time or learning how to crawl. So the first thing that they are going to reach for is the one thing in the house that is big, soft, clean, safe and washable i.e. the quilt lovingly made by the grandparent (gifted as an heirloom but doomed to a much more finite destiny).

I don't have any unfolded views of the mat - it is square with the feature fabric in the centre and a deep denim border..

So with this in mind, I made a cotton, padded floor mat. It is backed and bordered with denim. Intended for the floor, easy to wash and can be used as an underpad if my sister has any more precious quilts or handmade blankets that she wishes to protect - at least from the floor!
The second item (or the first, depending on how you look at it) is the receiving blanket:

It's cotton flannel on both sides. The feature fabric is Michael Miller's Bite Me Apples in Lime, which just happened to go nicely with the spotty green flannel that I picked up at a local quilt shop.

On the reverse side of the blanket, I stitched together a half of two different apples and hand appliqued the composite apple into one of the blanket corners. I stitched crudely but as neatly as I was able (cough) embroidered up the centre of the apple core to cover the join.

The third part of my present is the two pairs of bloomers (diaper/nappy covers). I used the bloomer pattern in Lotta Jansdotter's Simple Sewing for Baby book. I used some plain cotton (not flannel) that I picked up on ebay that matches the reverse of the receiving blanket.

I really like the way that they turned out. This is the first pattern that I've made from this book and I came across a couple of problems that I had to solve. Firstly, I made this in the 6-12 month size and I am not certain that the measurements given in the book for the leg bias binding strips are correct?

I cut mine to the length stated in the book, checked and checked again, but they simply were not long enough to attach in the way described in the book. I wonder if the measurement in the book is for the 0-6 month size and the 6-12 month length was omitted in error? I got around the problem by putting the instructions in the book to one side. I edge stitched the two ends of the bias strip together and eased the circular piece of bias binding into each leg in the way that I might do if I was stitching a sleeve into handknitted jumper. I just about made it.

Secondly, the book assumes that you have the baby underfoot. The idea is that you custom cut the elastic that you need for your baby's waist and legs - a bit tricky to achieve when I am in Vancouver and the baby is in Bangalore! So, I changed the the top to have a 3/4 - 1 inch waistband and used button elastic instead of the elastic stated in the pattern. I left 1.5" of the waistband open (over a side seam) and securely sewed a button in underneath. This way, my sister can adjust the waistband to whatever my niece requires. I completed the leg elastic as per the pattern but left them intentionally loose. I hand stitched the last 1.5" of the leg seams closed in a contrasting green thread and sent instructions with the bloomers on how to unpick the green part of the seam and shorten the leg elastic if she needs to. I have to be honest though. My sister doesn't sew - at all. So I am guessing that my niece will just have to put up with baggy leg apertures!

Voila!
My loosely cordinated set of floor mat, blanket and bloomers! You'll have to wait to see the knitted hat that my niece didn't get...I might just have popped it into a drawer for Spud!

Wednesday, 24 August 2011

To the outside world, he was a child actor, comedy producer and director. In my world, he happened to be a friend and one of my most favourite people. I feel very lucky to have known him.

I knew him through my sport (where it never really seems to matter what people do in the outside world). We competed for the same team. He was a skilled competitor, a great team member and an excellent coach. He was endlessly kind, incredibly bright, extremely funny, full of stories and a lot of fun. To boot, he was charming and a real gentleman (with just the right hint of scoundrel about him).

His passing leaves a massive gap and I will miss him enormously. My heart goes out to his wife Linda, his children as well as the rest of his family and his friends.

Monday, 8 August 2011

When I started writing posts for my blog again this year, I envisaged that I would:

say a little bit about IVF before I forget it all;

completely bore the pants off you all about my experience of being pregnant;

share my attempts at making clothes for the first time in my life using a bunch of maternity patterns that I picked up at my local Fabric Hell; and

fill my blog with nice pictures of the things that I am making for my niece and for Spud. Or at least, trying to make.

I am not doing very well, am I?!

The truth is that we have been run off our feet with Everything Else and I've barely got to my studio, let alone sat down at my PC to write blog posts or sat down at my sewing machine to sew.

The maternity patterns are sitting with a length of fabric in an untouched pile at my studio. Time issue aside, I emailed Roo recently and confessed that my bust and my tummy expanded faster than I could overcome my fear of opening the pattern packets. Now, with only 2.5 months left of my pregnancy, I do not really see any point in making clothes that I will probably never get to wear again. So if anyone would like a set of this year's maternity sewing patterns, let me know and I'll pass them along!

My knitting bag containing a couple of baby projects is languishing next to the sofa and my baby sewing projects are strewn across my studio. Their progress frozen in time to the day that my MIL died. Today, I am supposed to be at the studio working on completing a present for my neice as I need to get it into the post to the UK while my sister is there (visiting from India) but I am taking time out to do this blog post. You know how it is - steal time from one activity to do another?

Instead, I have:

attended to my MIL's funeral arrangements to save the Fella and his brother the upset of doing it;

assisted a lot with the sort out, clean up and necessary cataloguing (of her house and its contents) identifying what things to keep, go to auctioneers or off to charity. Including taking proper photographs of all significant pieces (general view, artistic detail and any maker's marks).

At this point, I should tell you that each and every room in her house is/was clogged, waist deep or higher, in belongings. So it hasn't been a small task and it is nowhere near complete yet.

My MIL was not a hoarder in the current, reality tv sense, she had just worked in the collectibles business for the past 30 years. She collected things as stock and laid them down like wine in her house to accummulate in value. The problem is that she collected an awful lot of different things, individually none of the items were of any significant value and she had no coherent storage system. So it's been a shell game of moving things from one room to another, putting the same category of things together and then trying to work out what on earth to do with them all.

This spate of activity at her house over the past month or two has led me to review my own belongings quite carefully. I recommend that you do too.

Ask yourselves, is there anything that you own that you really would not feel comfortable with someone else going through after you die? Please consider that this person might be someone you love. Or else, it might be someone that you are not all that close to at all. I am not sure which would be worse?

Since my MIL died, the Fella and I have each thrown out about 5 bin liners of clothes. In particular, I have been through my underwear and sock drawer and thrown out every last pair of old faithfuls in anything less than 100% perfect condition;

liaised with the designer and the builder who were supposed to be renovating the basement of our house this summer to create two new bedrooms and a bathroom - one for us and one for Spud - allowing us to turn our existing bedroom into a home office on the main floor of our house;

bitten down my deep disappointment when it became clear that Canadian builders are of a different yet similiar ilk to builders in the UK.

Although we started this project back in March, were reassured that the basement part of the project could be done (just) in time for the arrival of our baby and threw out or put into storage all of the things in the basement in April so that the builder could start whenever the designer was ready, we still do not yet have the city permits that we need to start work. (Courtesy of the designer taking 6 months to come up with a new basement floorplan and a new garage floorplan, most of which I did myself in the end because his design was unusable...would you put a baby-toddler bedroom on the opposite side of the house from its parents and make sure that its route to the bathroom was a night time trauma creating assault course down a long hallway, around a corner and through a laundry room? No? Me either.)

On top of this, the builder has confessed that he now has no time or resources to start our basement project properly until May/June 2012. So there will be no renovation this year, meaning no bedroom for the 1st year or so of Spud's life. I realise that Spud will be in our room for the first 6 months or so anyway. But still, it's disappointing.

In the meantime, the builder does have time and resources to work on our new garage. So we might have that done by.....Christmas? The only good that has come out of this delay is that the emptied home office in the basement can become a temporary guest room over the winter for members of my family who may want to come over to visit Spud. So we plan to paint it white and put a sofabed, bed, garment rail and a chest of drawers (dresser) in there before the baby is born. Next summer the furniture will be dumped, the room will be demolished and stripped back to the studs. It's an idiotic situation but there it is.

ordering some essential baby things - stroller (buggy), car seat and a crib (cot) that will work in a house with no nursery. We have the stroller but the car seat and crib are both pending. The ETA is 8-10 weeks, which is might be cutting it a bit fine. If the worse comes to the worst, I can bring Spud home in a taxi (no car seat needed for that I don't think) and the stroller has a basinette for Spud to sleep in at the start. Ikea seems to have run out of the Gulliver baby changing table that we like - it doesn't seem to be in stock anywhere on the West Coast of Canada and our local store have no idea when they will get it back in. So I am stalking their website weekly to see if we will be in luck. After all, I have 2.5 months and I can always change the baby on the dining room table if I have to.

I think that this just about summarises where I am?

Once I have my niece's present out of the way, I am hoping to settle down and work on some projects for Spud. So I hope to have some baby projects to show and tell in the near future.

I picked up a couple of baby clothes and accessory sewing books that look quite promising and might be a gentler route into working with patterns than maternity wear? Just on the basis that if things I make fall off my baby through my complete ineptitude, it might be less embarrassing than if they fall off me in the supermarket?!

This said, I'm not sure exactly how to achieve my list of things that I want to make before Spud is born. I need some kind of support or positive motivation to help me ring fence the time without interference from others. At the moment, it seems that it is too easy for me to be ambushed by those who do not think that my things are as important or urgent as the things that they want me to do for them.

It's very hard for me to say no when their activities are tied to something that is so emotional and upsetting for them. It makes me feel unsupportive, churlish and selfish to want to do my things rather than their things. I feel particularly guilty when I consider that part of my desire to do my things is that I get to do things sitting down, in clean, peace and quiet. Doing their things means that I have to spend my time standing, bending, kneeling and working in 30 years of dust, wearing a mask and plastic gloves in 25-30 degree summer heat.

The problem that I have is that I am more or less 3 weeks into month 7 and pregnancy is really only 9 months +/- 2 weeks either way. It takes time to make things properly. I don't want to end up not finishing the things that I want to make or making errors because I'm working in haste and feeling like I'm going to drop the baby at any minute.

But now I am starting to moan. So I am going to stop writing. Things just are the way they are. Onwards and upwards - off to do my niece's present I go!

Thursday was just one of those ordinary, idle days - all the way through, pretty much. We were tired because Spud is keeping me up at night, so we oven roasted some ribs, ate, set aside half a rack for the Fella to take over to his mother (she’s 80 and she lives close by so we often make extra when we are cooking to drop off to her) and by 10:15pm we were in bed, lights out, congratulating ourselves on getting to bed early for a good night’s sleep.

At 10:30pm, on the dot, came the blindsiding. The phone rang. The Fella answered and I could hear his mother’s panicked voice, “I don’t feel well. Can you come?” My husband was already rolling out of bed and reaching for his trousers, “I’ll leave right now.” I stayed in bed to keep out of his way while he grabbed the rest of his clothes and he headed out the door, saying, “It’s probably nothing, you try to get some sleep and I’ll be back in a little while”.

I lay there in the dark wondering whether or not I should really stay put or get dressed. As I lay there in the dark, I heard 1...then 2...then 3 sirens. It was about 10:42pm. My heart sank like a stone – it could have been coincidence but we live in a quiet part of Vancouver and the Fella’s mother only lives about 2 blocks up and 1 block over.

The phone rang. It was the Fella. He was in tears, “It’s bad - about as bad as it gets. The paramedics are here, working on my mother. I cannot get through to my brother on his cell phone. Can you find another number and ring him?” I said, “Ok. Stay with your mother and I will come find you - either at her house or at the hospital.” He said, “I am not sure if they’ll be taking her to a hospital.”

By sheer luck, I had stuck my BIL’s (Brother in Law) house phone number to the fridge recently. So I got up, phoned and luckily, he was in. I explained. He said, “I’ll leave now.” Then added, sounding a bit perplexed, “But I spent all afternoon with her. I left her at 6pm and she was fine.”

It was 10:50pm. I drove over to my MIL’s (Mother in Law’s) house. I wasn’t sure whether anyone would still be there but as I turned into her street I could see a fire truck and two ambulances parked outside her house. The Fella was standing on the lawn talking to one of the ambulance crew and my MIL was on a gurney, being wheeled across her front lawn towards an ambulance. Her face and shoulders were so pale that they almost appeared to glow in the dark.

The ambulance left with my MIL for the hospital and we waited to lock up her house while the crew from the other ambulance cleared away all of their equipment and discarded medical supplies from her hallway. While this was happening, the Fella explained that when he got there, he found that his mother had left the front door open for him. She was waiting for him, sitting in a chair in her hallway - coat and shoes on, handbag over her shoulder and her house keys in her hand – ready to go. He thinks that she tried to say something as he walked in through the door but then her eyes rolled upwards, she lost consciousness and was struggling to breathe. He dialled 9-1-1 straight away. The time on his cell phone was 10:40pm. He said that the firemen arrived first and helped his mother until the paramedics arrived.

When the crew had tidied up, I drove us to the ER where we completed his mother’s registration at the front desk and were shown to a Family Room by a social worker who told us that my MIL’s heart had stopped twice on the way to the hospital but that they had got it going again and were working on her now to stabilise her. It was about 11:20pm.

The family room was a blue-grey carpeted box with two sofas, two coffee tables, a spare hospital bed and a very small, lonely looking box of tissues. The social worker bought us both a plastic cup of water and we waited. The Fella was in pieces – in shock at finding his mother, the trauma of seeing the emergency crews work on her at her house and knowing that the situation was pretty bad. My BIL phoned us twice to update us on his ETA and we explained where he would find us.

Just before he arrived, two ER doctors came in to see us looking very glum. They explained very carefully that the situation was very serious and that they were trying to stabilise my MIL but they were not certain what was causing the problem. They warned that she seemed decided to go, rather than to stay and they said that without the assistance of the paramedics, she would not have made it this far. In a little while they said that they would take us in to see her. They left. My BIL arrived. We waited some more.

Eventually, the social worker came back, warned us that my MIL was hooked up to a breathing machine and then we were ushered through the ER to see her. We walked into a brightly lit, busy area with 4 work areas, separated by dividers. It was just like walking into a hospital television drama set. I looked at the floor as there were other people being worked on when we walked in. The medical staff looking after my MIL had stepped back to allow us through to see her. She was almost unrecognisable - chalky white, naked (partially covered up by some kind of blue rubber pad), surrounded by machinery, intubated and her chest was heaving up and down mechanically with the rasping of the breathing machine.

I stood back to give the Fella and my BIL some space but they appeared as bewildered and disorientated as I felt. It didn’t look possible to get close enough to touch her through all of the machinery, so all they could do was stand and look at her from about 6ft away. The medical team ushered us back out to the Family Room so that they could continue working. The social worker said that they were preparing her to go up to the Cath Lab. We waited.

Two new people came to see us in the Family Room. One of them, a man, introduced himself as the Cardiologist. He asked who had found my MIL and asked the Fella some very specific questions,‘Was she breathing when you arrived at her house?’

‘She was trying to.’

‘Was she breathing – yes or no?’

‘She was trying to, yes.’

‘What time did she ring you at your house?’

’10:30.’

‘What time did you call the paramedics?’

’10:40.’

‘What was her health like before today?’

‘She was on high blood pressure medication but she was very able and independent. She lived alone, still drove a car and ran her own business, working at weekends.’

The cardiologist outlined two options, saying that the Fella and my BIL needed to decide how to proceed.

The first option was to intervene further. It was thought that my MIL had a clot, a blockage, in her heart. They could take her up to the Cath Lab right away, prepare her for surgery and perform an angioplasty. The surgery would take about 15 minutes and the hoped outcome would be that her blood pressure would stabilise. However, he warned that her condition was considered critical, that there was a high risk that she could die on the operating table and it was not 100% guaranteed it would resolve the problem.

The second option was not to intervene further. He would instruct the ER team to step back and adopt a palliative care strategy. They would make my MIL comfortable and we could spend her remaining time with her. He confirmed that without surgery, there was no possibility of recovery at all.

As you can imagine, there was a lot of discussion at this point. I kept quiet except to ask clarification questions and follow up questions to elicit more information from the doctor. The penny dropped for the Fella and my BIL that the reason the cardiologist was asking all those pointed questions about breathing, timings and previous state of health was that he was trying to rule in or out whether she might have sustained some kind of brain trauma from lack of oxygen and whether she would be fit enough to recover from the surgery/the entire experience.

When they asked about this, the cardiologist could not offer any guarantees. My BIL asked whether they could check brain function before surgery, he said that they could but that would delay the heart surgery by a further 30 plus minutes. If they decided to proceed, then they needed to do the procedure straight away. He did say that he thought it was a positive sign that she’d been coherent on the phone to the Fella at 10:30pm, that the emergency services had got there very shortly after 10:40pm and that she had fought the intubation in the ER. Apparently, you have to be pretty much a vegetable if you choke that down without any resistance. Although, I think that the phrase the doctor was much more politically correct. He said something like, ‘they worry about whether someone has sustained neurological damage if they don’t fight the intubation.’

At the end of this part of the discussion, it was not clear that proceeding with surgery was the right thing to do or not. It might/might not help to stabilise her, she might/might not survive the procedure and she might/might not be okay afterwards.

So, the discussion turned to what my MIL would want if she was there and able to speak for herself. I can vouch for the fact that she’s a fiercely independent woman with a very strong set of views and a very particular outlook on life. As it happens, she had retired from working at this hospital some 20 years earlier as a Social Worker. According to her two sons, she wasn’t very fond of sick or infirm people and she certainly wouldn’t want to be one herself.

I think that the big worry for the Fella and my BIL (not for them but for her) was that she would survive surgery only to face a long recovery, be physically or mentally disabled in some way, be unable to live her life on her own terms and have the rest of her life overshadowed by the fear of having to go through something awful like this again. Very upset, they concluded that if she had been there in the room to speak for herself, she would not have wanted the surgery.

So they opted for palliative care. The cardiologist left to speak to the ER team. The social worker came by and said that she would take us through to see my MIL again before they took her off the breathing machine. This time, I opted not to go – I thought that her sons should be have some time with her on her own and I did not need to see her in the way that I had seen her before. When they came back, the social worker said that after they had taken her off the breathing machine, they would move her to a private room and we could spend as much time with her as we wanted. We waited again. What was the time at this point? I knew but I have forgotten already.

You know, in my naiveté and from watching too much ER, I thought that when they switched off her breathing machine, that would be it. I guess that I was preparing myself to spend time in a room with a dead body for us all to say goodbye to my MIL after she had died.

So it was with some surprise that I walked into the ER ward cubicle and found that my MIL was still alive - unconscious, intubated and hooked up to two drips and oxygen but still very much alive. She looked like she was having a rough night’s sleep but it certainly didn’t look like she was about to gasp her last.

The nurse explained that she was breathing on her own and was medicated so that she wasn’t in any pain. He said that we could stay with her for as long as we wanted. If she was still with us at the 7am shift change, that they would probably move her to a Family Practice Palliative Care bed. I cannot remember what the time was at that point but when the nurse said 7am, I remember feeling - courtesy of my regular bouts of insomnia – that it was a time on the clock above the hospital bed that felt like it was half a lifetime away from the current time on the clock.

So we sat, we watched her breathe, we chatted and, effectively, I suppose that we waited for her to die. We were not sure what else we should do - where else would we be?

It was a long night and after the initial drama, the rest of the night was quite peaceful. We sat around her bed and, at one point, we thought her colour had improved greatly. She was breathing so well, we wondered if she might pull through. We asked the nurse about her condition when he came in to suction her breathing tube but instead he confirmed that the way her breathing had started to change was a clear indication of her body starting to fail.

At about 4:30am or so, her breathing became more shallow. A doctor came in and told us that he was going to remove her breathing tube to make her more comfortable. The nurse who removed it was ever so gentle. She spoke to my MIL as though she was awake and conscious, speaking to her by name, telling her exactly what she was doing, what she needed to do and how she might feel the need to cough. After she removed the tube, my MIL breathing was more laboured, so the nurse raised the head of the bed so that my MIL could breathe more easily. Once the bed was raised up, a lot of her colour drained away again and it was clear that she was not doing well at all.

At some point after that, I went outside for some fresh air. While I was outside, I phoned my father to tell him what had happened. I must have been on the phone for longer than I realised as when I got back, it was 6:10am, my MIL had died and the social worker was there to hand us some information leaflets.

I think that the last time I saw a dead body was when when I saw my grandmother in her coffin at her wake. It took me a long time to get over that as she didn’t look at all like the grandmother I knew and loved. This time though, it didn’t feel odd or strange to be in the same place as my MIL’s dead body. It felt like a natural progression from the rest of the night. She had been breathing and now she had stopped. She was sitting up in the bed, looking distinctly grey with her eyes closed and her mouth ajar. I felt a bit relieved for her that her ordeal was over. I do not feel badly that I was not there at the very end. In some respects, I thought that it was right that it was just her together with her sons.

The social worker told us that we could continue to stay with my MIL for as long as we wanted. However, the Fella felt that he’d said his goodbye and now that she had gone, he felt that we should go as well. So I said goodbye to her and as we left, the Fella did something that he often does to me if he is up and I am still in bed - he affectionately wiggled his mother’s foot through her bedcovers and said, ‘Goodbye Polly’.*

‘Polly’, Fella's Family Matriach: 1930 – 2011.

Notes

*A pet name that he and his mother used to call each other. They used to have a parrot.

Written with many thanks to everyone from our local emergency services and hospital who worked on my MIL - your efforts gave us the extra time we needed to say goodbye properly. We're all okay - the Fella is grieving and we are gently taking each day at a time.